It’s been a pretty good year to be a Jets fan and hopefully more good things to cheer about in the months to come, but the same can’t be said if your name is Dustin Byfuglien. First, a concussion in the early months of the season, an ankle injury in December and then a mystery injury that occurred a few games after he returned in February. It seems like ages since we’ve consistently seen him on the ice, so why has he been gone for so long? We’ll breakdown the first injury that happened in December and what could’ve happened when he returned.
Dec 29th, 2018:
Dustin Byfuglien goes into the corner with Luke Kunin and seems to injure his ankle. He immediately left the game and was ruled out for “at least” 4 weeks. They labeled it an ankle injury that would not require surgery. So what exactly did he injure?
Based on the way his ankle goes in it would be easy to assume that he suffered a lateral ankle sprain, but a typical ankle sprain doesn’t take 4 weeks to heal, especially for a hockey player where the skate would keep the lower ankle stable. If it was a lateral ankle sprain he would’ve been able to return to action within the week. Based on the extended time table we can speculate that what he actually suffered was a high ankle sprain, a far more debilitating injury.
What is a high ankle sprain?
The ankle is the connection point between the bottom part of the tibia and fibula on a bone called the talus. This connection point is where most of the movement of our foot occurs, and because of this it also needs to be a stable structure.
On the inside of the ankle, there is a collection of ligaments called the deltoid ligaments which hold the tibia to the inside of the foot bone. This ligament is less commonly injured, and is done so when the ankle rolls out, an example would be someone landing on the outside of your foot, overstretching the inside ligaments.
On the outside of the ankle we have a collection of 3 ligaments that holds the fibula to the calcaneus and talus. This is the most common ligament complex injured in the ankle, and is commonly thought of when someone has “rolled” their ankle.
An ankle ligament complex that is less talked about is the distal tibiofibular syndesmosis. This is a complex of connective tissue that attaches the tibia and fibula together to provide stability at the ankle. It consists of 4 ligaments: the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, the interosseous ligament, and the transverse tibiofibular ligament. This complex provides stability at the ankle, and when torn it is referred to as a high ankle sprain, and can take quite a while to heal.
How do you get a high ankle sprain?
The most common mechanism of injury is when the foot and ankle is forced into external rotation (rotates away from body). This causes the talus to exert a force great enough to separate the tibia and fibula away from each-other. This commonly occurs when an athlete plants their foot facing away from their body (externally rotated) and then rotate internally or an inward force is applied to the leg while the foot is planted. Less commonly, the tibiofibular syndesmosis can become injured with inverted and plantar flexed foot (pointed foot).
During hockey the ankle becomes at a greater risk for a high ankle sprain due to the stability of the skate. The skate is a stable, protective structure to the lower ankle ligaments, but leaves the tibiofibular syndesmosis more receptive to injury. Since the lower ankle is held in a stable position, if the ankle wants to move/is forced inwards or outwards this movement will have to occur at the distal tibiofibular syndesmosis, since the lower ankle joint isn’t able as it normally does. The tibiofibular syndesmosis is created to be a stable structure, so when it is asked to move above what it is used to, injuries can occur.
So what happened to Dustin Byfuglien?
This is purely speculative since they were vague about the injury. My best guess is that when he rolled his ankle his ice skate stabilized the lower ankle, thereby translating all of the inward force to the outside structure of the tibiofibular syndesmosis: the anterior inferior and posterior inferior tibiofibular ligament. Since the injury was purely an inward force with no noticeable external rotation, we may be able to rule out any injury to the interosseous ligament between the tibia and fibula. Again, speculative. Yes, high ankle sprains more commonly have an external rotation mechanism of injury but that is not the only way they can happen. The lateral force may have been so great that it caused tibia + fibular separation without an external rotation force.
Why was he out so long?
The return to play recovery time for a lateral ankle sprain is approximately 1-6 days. The return to play timeline for a high ankle sprain is approximately 45 days. They take longer to heal because it is a bigger ligamentous complex and has more responsibility when stabilizing the ankle during weight bearing movements. Hockey also requires a lot of stability of the ankle as well, perhaps more than most sports. The constant stopping, starting and transitioning from skating forward to backwards requires a lot of rotation of the ankle. If the ankle is not fully healed, reinjury is much more likely to occur.
He was likely held out for such an extended absence because the rehabilitation process involves the player being able to weight bear and skate without any pain. This was most likely the biggest hurdle he had to overcome, transitioning from forward to backwards, pivoting etc.
Feb 14th, 2019:
Dustin Byfuglien was injured at the end of the game when got “tangled up”. Apparently it was an injury to the opposite leg, completely different from his ankle sprain. Typical NHL, it was a “lower body injury” and he ended up missing another 6 weeks. Could it have been the same leg? Maybe. It is very possible that he reaggravated the ankle and the Jets wanted to draw attention away from that, or he could have very well injured the opposite leg. With an absence as long as 6 weeks, a knee ligament injury seems possible and you could make the argument for it. Without the mechanism of injury it is hard to say, so lets just be happy he is back :)
In a nut shell, Dustin Byfuglien injured an ankle complex that is less commonly injured than the lateral ankle ligaments, but occurs far more common in ice hockey and takes a lot longer to heal than a “rolled ankle”. The injury that occurred in February will forever be a mystery, and maybe they will tell us in the offseason, after they win the cup :)
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Stay strong, stay heathy.
Doctor of Chiropractic, B.HKin.